P rocedure Guideline for Hepatic and Splenic Imaging 3 . 0

The purpose of this guideline is to assist nuclear medicine practitioners in recommending, performing , interpreting, and reporting hepatic and splenic imaging studies. A. Liver–spleen imaging is performed after the injection of a 9 9 m Tc-labeled colloid that has been rapidly phagocytized by the reticuloendothelial cells of the liver, spleen, and bone marrow. B. Liver blood pool imaging is performed after the injection of 9 9 m Tc-labeled red blood cells for the detection of cavernous hemangiomas of the liver. C. Hepatic perfusion studies are performed after the injection of 99m Tc-macroaggregated albumin (MAA) through a hepatic artery catheter to determine that intra-arterially administered agents are delivered optimally. D. Splenic imaging is performed after the injection of 9 9 m Tc-labeled heat-damaged red blood cells. Damaged red blood cells are taken up selectively by functioning splenic tissue. A. Liver–Spleen Imaging This study can be used for determining the size and shape of the liver and spleen as well as for detecting functional abnormalities of the reticu-loendothelial cells of these organs. Specifically, these studies are occasionally performed: 1. For suspected focal nodular hyperplasia of the liver. These lesions often have normal or increased uptake on sulfur colloid imaging. 2. To assess the function of the reticuloendothe-lial system in patients with suspected liver disease. The decision to perform a liver biopsy or to continue treatment with a hepatotoxic agent may be influenced by the severity of liver disease that is seen on liver–spleen imaging. B. Liver Blood Pool Imaging This test is highly specific for cavernous heman-giomas of the liver. The sensitivity for detecting lesions of the liver (>2–3 cm) is also high. He-mangiomas as small as 0.5 cm may be detected with single-positron emission computed tomog-raphy (SPECT) using a multihead camera. C. Hepatic Perfusion Imaging This study is useful for demonstrating that hep-atic artery catheters used to infuse chemothera-peutic or therapeutic radiolabeled microsphere agents are positioned optimally to perfuse liver tumors and to avoid perfusion of normal extra-hepatic tissues (e.g., stomach). D. Splenic Imaging This study is used for detecting functional splenic tissue. This study is often performed: 1. In children to rule out congenital asplenia or polysplenia 2. In adults whose thrombocytopenia has been treated previously with splenectomy 3. For characterizing an incidentally noted mass as functional splenic tissue A. Patient Preparation No patient preparation is required. B. Information Pertinent to Performing the Procedure 1. Relevant history and results …